title: The association between race and gender, treatment attitudes, and antidepressant treatment adherence.
abstract: OBJECTIVE
  We examined the associations between treatment attitudes and beliefs with race-gender differences in antidepressant adherence.
  
  
  METHODS
  Subjects (n = 186) were African-American and White subjects aged ≥60 years, diagnosed with clinically significant depression, and had a new outpatient primary care recommendation for antidepressant treatment. Antidepressant adherence was assessed using the Brief Medication Questionnaire. Attitudes and beliefs were assessed using the Patients Attitudes Toward and Ratings of Care for Depression, two items rating perceived medication importance, and a modified version of the Stigma Scale for Receiving Psychological Help.
  
  
  RESULTS
  African-American men and women had significantly greater concerns about antidepressants and significantly less understanding about treatment than White women. African-American men had significantly more negative attitudes toward healthcare providers than African-American and White women. African-American women were more likely than White men and women to endorse a medication other than their antidepressant as most important. Whereas some race-gender differences were found in personal spirituality, no group differences were found in perceived stigma. In a logistic regression model adjusted for key baseline variables, White women were significantly more adherent to antidepressants than African-American women (OR = 3.05, 95% CI = 1.06-8.81). Fewer concerns about antidepressants and indicating the antidepressant as the most important medication were both significantly associated with adherence. After including either of these two variables, the adherence difference between White women and African-American women was no longer significant (OR = 2.56, 95% CI = 0.84-7.80).
  
  
  CONCLUSIONS
  Concerns about antidepressants and the importance of antidepressant medication are associated with adherence and are potentially modifiable through improved patient-provider communication, psycho-education, and therapeutic interventions.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Inger
authors.initials: I
authors.lastname: Burnett-Zeigler
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Claire
authors.initials: C
authors.lastname: Chiang
authors.forename: Janet
authors.initials: J
authors.lastname: Kavanagh
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.forename: Katherin
authors.initials: K
authors.lastname: Rockefeller
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Sirey
authors.forename: Helen C
authors.initials: HC
authors.lastname: Kales
mesh_terms: D001741:Black or African American / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D016017:Odds Ratio; D012737:Sex Factors; D057545:Social Stigma; D044465:White People / Q000523:psychology; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents
keywords: antidepressant adherence; race/ethnicity; spirituality; stigma